Revenue Integrity Coding Billing Specialist - Remote

Guidehouse; United States; Remote; USD 55,000 - 65,000; Full time

Job summary

A leading consulting firm is seeking a Revenue Integrity Coding Billing Specialist for a fully remote position. This role involves reviewing and resolving Medicare and third-party payer accounts to adhere to billing compliance guidelines. The ideal candidate will have significant experience and certification in coding practice, making them an integral part of the revenue cycle team.

Qualifications

• 5+ years of experience in Revenue Integrity.
• Ability to determine medical necessity of services based on documentation.
• Knowledge and application of UB-04 billing and reporting requirements.

Responsibilities

• Resolve standard billing edits such as Correct Coding Initiative.
• Review clinical documentation to confirm and apply applicable codes.
• Ensure coding and billing practices follow Federal/State guidelines.

Skills

ICD-10 Coding

CPT Coding

HCPCS Coding

Knowledge of Medicare guidelines

Knowledge of Medicaid guidelines

Education

High School Diploma/GED

AAPC or AHIMA coding certification

Associate degree (preferred)

Job description

Revenue Integrity Coding Billing Specialist - Remote

Join to apply for the Revenue Integrity Coding Billing Specialist - Remote role at Guidehouse

Revenue Integrity Coding Billing Specialist - Remote

Join to apply for the Revenue Integrity Coding Billing Specialist - Remote role at Guidehouse

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Under the direction of the Director of Revenue Integrity, the Revenue Integrity Coding Billing Specialist provides revenue cycle support services through efficient review and prompt resolution of assigned Medicare and third-party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. This position is 100% remote. Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity Hold Codes in the hospital billing scrubber. Tasks associated with this work include resolving standard billing edits such as: Correct Coding Initiative, Medically Unlikely Edits (MUE), Medical Necessity edits, Other claim level edits as assigned. As needed, review clinical documentation and diagnostic results as appropriate to confirm and apply applicable ICD-10, CPT, HCPCS codes and associated coding modifiers. Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system. Ensures coding and billing practices follow Federal/State guidelines by using diverse types of authoritative information. Maintains current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements. Other duties equal with skills and experience as determined by the Director of Revenue Integrity. Requirements include High School Diploma/GED, 5+ years of experience in Revenue Integrity, AAPC or AHIMA coding certification, experience in ICD-10, CPT and HCPCS Level II Coding, ability to determine medical necessity of services provided and charged based on provider/clinical documentation, knowledge and proper application of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements including resolution of CCI, MUE and Medical Necessity edits applied to claims, ability to determine accurate medical codes for diagnoses, procedures and services performed in the outpatient setting, knowledge of current code bundling rules and regulations, knowledge and understanding of hospital charge description master coding systems and structures, and ability to produce correct, assigned work product within specified periods. Preferred qualifications include hospital medical billing and auditing experience and an associate degree.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Business Consulting and Services

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